Our objective was to examine the impact of palliative care (PC) on aggressive care near death for patients with advanced pancreatic cancer. Measures of aggressive care included (i) chemotherapy within 14 days of death; (ii) more than one emergency department (ED) visit; (iii) more than one hospitalization; and (iv) at least one intensive care unit (ICU) admission, all within 30 days of death. A retrospective population-based cohort study was conducted with patients diagnosed with advanced pancreatic cancer in Ontario. Multivariable logistic analyses were performed. Our final cohort consisted of 5,381 patients (median survival of 75 days). 52% received a PC consultation. PC consultation was associated with decreased use of chemotherapy near death (OR=0.34); and lower risk of ICU admission (OR=0.12), multiple ED visits (OR=0.19), and multiple hospitalizations near death (OR=0.24). A per unit increase in the monthly rate of PC visits was associated with lower odds of aggressive care.

Our objective was to examine the impact of palliative care (PC) on aggressive care near death for patients with advanced pancreatic cancer. Measures of aggressive care included (i) chemotherapy within 14 days of death; (ii) more than one emergency department (ED) visit; (iii) more than one hospitalization; and (iv) at least one intensive care unit (ICU) admission, all within 30 days of death. A retrospective population-based cohort study was conducted with patients diagnosed with advanced pancreatic cancer in Ontario. Multivariable logistic analyses were performed. Our final cohort consisted of 5,381 patients (median survival of 75 days). 52% received a PC consultation. PC consultation was associated with decreased use of chemotherapy near death (OR=0.34); and lower risk of ICU admission (OR=0.12), multiple ED visits (OR=0.19), and multiple hospitalizations near death (OR=0.24). A per unit increase in the monthly rate of PC visits was associated with lower odds of aggressive care.

People with advanced cancer may have significant challenges to their physical, emotional, spiritual, and social well-being. However, some individuals are able to experience an overall sense of well-being in spite of these challenges. This study sought to understand the experience of well-being from the perspective of people with advanced cancer. Guided by interpretive descriptive methodology, eight participants were interviewed and the data were analyzed using the constant comparative approach. The participants took an active role in their well-being experience and described four main themes: view of self, the fluctuating nature of well-being, choices made to enhance well-being (including choosing supportive relationships, putting one‟s own needs first, treatments, focusing on the positive, and honoring the negative), and living in ambiguity. These findings have implications for nursing practice, nursing education, and health care organizations. / Graduate

Palliative radiotherapy (PRT) is proven to be effective in palliation of symptoms for end-stage cancer patients. However, little is known about its utilization at the end of life. This research aims to examine the utilization and the practice patterns of PRT at the end of life for cancer patients in British Columbia using population-based data. The pattern observed for PRT1Y dose-fractionation practice in BC are in line with published clinical guidelines and evidence from the literature, which advises “proper” use of PRT in BC as delivered to cancer patients at the end of life. However, after controlling for age, primary cancer site, and survival time, geographic access is found to be significantly associated with PRT1Y utilization. Variations found in PRT1Y rates by geographic access, which is operationalized by the Health Services Delivery Area (HSDA) and travel time, suggests potential underutilization of PRT1Y for patients with suboptimal access. / Graduate / 0992 / 0769 / 0574 / jinhuang@uvic.ca

This thesis demonstrates relations among health, social network, ADL and patterns of care in the oldest old guided by a resource theoretical model. The analyzed data are based on two studies: the Nona study, a longitudinal study of 157 individuals aged 86 to 94 years, and the H70 study, a longitudinal study of 964 individuals aged 70 at baseline. Data were collected by interviews and to some extent in the H70 study, medical exams and medical records. The results demonstrate that perceived resources seem to affect patterns of care to a higher extent than the more objective resources in the sample of the oldest old. On the other hand, sociodemographic variables such as gender, marital status and SES, in addition to the more objective resources of having children nearby and the number of symptoms of illness predicted institutionalization during a subsequent 30-year period from the age of 70. The proportion of elderly persons’ institutionalization was further significantly higher than that generally found in cross-sectional studies. ADL was one of the strongest predictors for both use of formal care and institutionalization in both samples, indicating an effective targeting of the formal care system in Sweden. The care at end of life in the oldest old is challenged by the problems with progressive declines in ADL and health, which makes it hard to fit in the dying oldest old in the palliative care system. There is a need to increase the knowledge and the possibility for care staff to support and encourage social network factors and for decision-making staff to consider factors beyond ADL.

Background: According to World Health Organization is palliative care a human right. The focus of palliative care is relieving suffering and having quality of life as the main goal. The nurse's role is to enable symptom control, to be a support for the patient and close relatives, as well as contributing to a good and worthy death. Although death is a part of life, strong feelings arise about death and the dying. Aim: The aim of this study was to describe nurse experiences of palliative care. Method: The method used was a literature study based on international qualitative research. Eleven articles were analyzed and resulted in four main themes and nine sub-themes. Results: The findings were four main themes; the profession, relationships, work environment and feelings as well as nine sub themes; experiences and knowledges, the patient, relatives, stress, support from colleagues, lack of support from colleagues, grief and impotency, satisfaction and mental strain. Conclusion: The nurse’s experience of palliative care is individual and varies depending on, experience, interaction with colleagues and self-perception regarding individual values and existential questions.

abstract: Over recent decades, euthanasia has been a topic of increasing debate. With legalization of euthanasia in the states of Oregon and Washington and attempted reform in several other U.S. states and nations worldwide, it has become increasingly important to understand the roles and values of helping professionals who might be working with clients considering this option. The current study targeted 85 undergraduate students, 54 doctoral students in counseling psychology, and 53 doctoral-level professionals in psychology to assess both their personal values regarding euthanasia and their willingness to allow a client the autonomy to make a decision about euthanasia. Several factors were analyzed in regards to their relation to client autonomy and attitudes toward euthanasia, including age of client and sex of client. These variables were manipulated in vignettes to create four scenarios: a 24 year old male, 24 year old female, 80 year old male, 80 year old female. Other factors included level of education of the participant, spirituality and strength of religiosity of the participant, and personal experiences with deaths of friends or family members. Results indicated that more education was associated with greater support for euthanasia and that stronger religiosity and spirituality were related to less support for euthanasia. This study also found that participants did not exhibit differential levels of support based solely on the age or the sex of the client depicted in the vignette. Results further indicated that for doctoral students and professionals the loss of a loved one, regardless of cause of death, did not have a significant effect on their attitudes toward euthanasia. It is important for training programs to be aware of these findings in order to monitor trainees in terms of personal biases in the therapy relationship. With objectivity a high priority while working with clients, it is necessary to be aware of outside factors potentially influencing one's work with clients surrounding this value-laden issue. / Dissertation/Thesis / Ph.D. Counseling Psychology 2011

This qualitative phenomenological study attempts to gain the physician's essences, meanings and understanding surrounding death and dying. Starting with themes revealed in literature, in-depth interviews were used to ask selected physicians providing care: How does death affect them? Are physicians receiving adequate training in end-of-life care? Does the medical culture still see death as failure? How do they find meaning in end-of-life care? Using three different groups of physicians: early in career, mid-career, and retired, this research attempted to examine the phenomena of death and dying over apparent time and developmental experiences of physicians. Results: Physicians have not been adequately trained to handle end-of-life care. Communications skills, specific end-of-life care training and support for physicians dealing with death and dying are needed.

Many people need palliative care in the end of life. In palliative care, the ones closest to the dying patient has a central role. Previous studies have shown that it can be a challenge for the nurses to care for the ones closest to the dying patient because they carries a lot of emotions. The aim of this study was to describe nurse’s experiences of meeting relatives in end of life care. The method used in this study was a literature review based on qualitative studies. Twelve articles were analyzed according to Friberg’s (2017) qualitative content analyze in five steps for literature-based studies. The result showed that nurses experienced the meeting with relatives as a journey. Three themes emerged from how the nurses experienced the meeting with relatives in end of life care: The support from the start of the journey until the end, Together through the journey and Challenges during the journey. The conclusion is that it is challenging for the nurses to meet the relative in end of life care. It is a lot of feelings involved and the nurses have to think about many things to give as good care as possible.

Det blir allt vanligare med människor som vårdas palliativt i hemmet. I och med det blir det vanligare att närstående är en del av vårdprocessen. Närstående ställs då inför en helt ny roll gentemot den anhörige. De upplever svårigheter med att bibehålla ett normalt familjeliv då hemmet mer och mer börjar likna ett sjukhus, samtidigt som de vet att de inte skulle klara sig utan hjälpmedlen. Upplevelsen för närstående att ha en döende familjemedlem är påfrestande. Den närstående är inte längre bara en familjemedlem eller vän utan någon som den sjuke är beroende av. För att kunna axla denna roll behöver den närstående stöttning från sjuksköterskan, vänner och familj.   För att sjuksköterskan ska kunna ge det stöd närstående behöver är det viktigt att få en uppfattning om den närståendes upplevelse av den palliativa vården i hemmet. För att ta reda på detta valdes en litteraturstudie till examensarbetet. 12 kvalitativa artiklar analyserades till resultatet vilket mynnade ut i tre teman, att ta ansvar i vårdandet, att ha behov av stöd och att möta döden.  Resultatet visar att de närstående känner ett ansvar i vårdandet. Vissa uttrycker att de inte har något val, de sätter sig själva åt sidan för att kunna uppfylla löftet att vårda den sjuke. Andra känner att det är en självklarhet. De tycker att det är en naturlig del av livet och en möjlighet att få vara nära sin älskade på slutet. Det är viktigt med stöd från sjukvårdspersonal, vänner och familj för de närstående. Brist på stöd gör att närstående känner sig övergivna. Det är lätt att den närstående blir isolerad och bunden till hemmet under vårdtiden och för att klara av det krävs det stöd från utomstående. Närstående tycker att det var svårt att prata om döden, speciellt med den sjuke. De upplever att det är lättare att diskutera döden och sjukdomen med sjuksköterskan för att inte oroa den sjuke i onödan. De känner sig ständigt konfronterande med döden men de uppskattar att de kan vara närvarande och där för den sjuke på slutet. / Background: In recent years, it has become increasingly common for patients to choose to end their life at home. Relatives often wants to fulfill the wishes of the sick person, but are often poorly prepared to act as caregivers and experience lack of continuity, insufficient information and poor treatment. The experience of relatives having a dying family member is stressful. Aim: The aim of this study was to describe the experiences of relatives in palliative homecare.  Method: A literature based study with 12 qualitative articles were performed using the Friberg method of analysis. Results: The result showed that some relatives felt that taking care of their family member where a matter of course and others felt that they had no choice. It was important for the relatives to have support from healthcare professionals, family and friends. Lack of support made them feel abandoned. It was difficult to talk about death with the dying family member and relatives expressed that it was easier to talk to the nurse about it.  Conclusion: Death was constantly present, despite that death was hard to talk about with the sick person. It was also hard for the relative to be responsible for someone else and they felt that they were isolated in their own home. The relatives felt therefore the need to be supported by the nurse. They needed to be able to talk to the nurse and feel safe to fulfill the feeling of support.